Cord Blood Banking
Cord blood banking is gaining popularity across the world recently and the trend is also catching up in Malaysia. Cord blood is known to be rich in stem cells, which are young generic cells in the human body which could be grown into other specific cells, tissues and systems. Cord blood stem cells have been used to treat numerous diseases especially in blood disorders such as Leukaemias and Thalassaemias. The use of cord blood stem cells has gradually replaced Bone Marrow Transplants in the treatment of some diseases.
At the moment, there has been growing evidence to show that stem cells have great potentials in treatment of certain diseases such as Diabetes Mellitus, myocardial infarct and liver diseases. There has been some good evidence to suggest that stem cells may be able to treat other diseases including strokes, paralysis, endocrine diseases and the potential is unlimited. Many developed countries are racing to uncover the secrets of stem cells in hope that it provides the cure for diseases.
What is the advantage of storing my baby’s cord blood?
The cord blood of your baby is abundant source of stem cells, which can potentially be used to treat diseases in the future for your child or other family members. It serves as a type of insurance and gives you an option for treatment should the need arises.
The collection of the cord blood is easy, painless and safe for your baby. It does not involve anaesthesia and the collection is done by a trained healthcare worker.
How is cord blood collected?
The collection of cord blood is done after the delivery of the baby whereby the baby has been separated from his/her umbilical cord. A needle is inserted into the umbilical vein to collect the cord blood. Cord blood collection should not interfere with the delivery of the baby.
Where could I store my baby’s cord blood?
At the moment in time, there are no facilities for public cord blood banking. There are 4 main private companies that provide private cord blood banking services, including Cellsafe International, Cryocord & Stem Life. These companies provide privately run blood banks to store your baby’s cord blood.
Recently, the National Blood Bank in Malaysia accepts donation of cord blood from patients. These donated cord blood is used for testing and research purposes and does not incur a cost. If you are interested to donate you baby’s cord blood, you could contact the National Blood Bank for further information: www.pdn.org.my
What should I do if I want to store my baby’s cord blood in a private cord blood bank?
We suggest that you contact these private cord blood banking companies to understand further the services they provide. After you have decided to store your baby’s cord blood with a particular company, you would need to sign an agreement with the respective company. You would be provided with a set of special containers and kits by the company.
It is important that you let your healthcare provider know that you wish to collect your baby’s cord blood so that they could support your decision and help you to collect the cord blood.
When you go into labour, you should bring along the collection kit provided by the company and hand it over to your healthcare provider.
What happens to the cord blood after the collection?
After the collection of the cord blood is completed, your partner should call up the respective cord blood banking company and their logistic team will collect the cord blood from the hospital. Upon reaching the laboratory facility, the cord blood is processed and stored.
What are the health risks to the mother or to the baby?
In normal circumstances, there are no health risks related to cord blood collection as the cord blood is retrieved from the umbilical cord after it has been cut. However, in some circumstances, cord blood collections become unsafe due to several reasons as below:
- if the normal practice for managing the third stage is altered or delayed to promote successful cord blood collection, e.g. withholding controlled cord traction in the presence of a postpartum haemorrhage or maternal risk factors such as severe pre-eclampsia, in an attempt to maximize the volume collected with the placenta still inside the womb
- if routine maternal or neonatal observations are neglected
- The logistic burden of collection interferes with the healthcare provider’s attention, when it should be focused on minimising adverse neonatal outcome and postpartum haemorrhage
What are the issues surrounding cord blood collections?
- The collection procedure must be undertaken either during the third stage (while the placenta remains inside the womb ) or shortly thereafter, a time where there is a risk of post partum haemorrhage and when both mother and baby require one-to-one care
- There is pressure to ensure a sufficiently large volume is collected, since the likelihood of successful transplantation of cord blood Human Stem Cells is related to the volume and cell dose collected.
- The cord blood can become contaminated with bacteria during collection unless stringent precautions are taken to avoid this.
- The use of midwifery or medical staff for cord blood collection may distract them from the care of other mothers and babies.
What are the specific circumstances where cord blood collection may be difficult?
(1) Prematurity:
Early cord clamping appears to be disadvantageous to the preterm infant. Preterm babies are at risk of anaemia and haemodynamic instability. Studies has shown that there is some evidence that 30–120 seconds delay is associated with fewer transfusions for anaemia and fewer cases of bleeding in the young baby’s head. Therefore, it may not be appropriate to clamp the umbilical cord early in these babies and this may affect the amount of cord bold collected.
(2) Caesarean section:
Standard practice at caesarean delivery is to clamp the cord immediately and pass the baby to an attendant, then deliver the placenta and proceed to close the womb incision. Rapid action minimises maternal blood loss from surgery. Undue delay to effect collection or any delay where there is increased risk of haemorrhage would be inappropriate.
(3) Multiple pregnancy:
The logistical burden of collection increases substantially at twin and high order multiple deliveries, when the healthcare provider’s attention has to be even more focused on preventing adverse baby outcome and postpartum haemorrhage. Identifying which cord blood is associated with which infant in non-identical multiple births is necessary if the cord is for autologous use and would require tissue typing or other matching techniques which not all commercial cord blood banks undertake.
Recommendation from the Royal College of Obstetricians & Gynaecologists (UK):
- There should be no alteration in ‘usual management’ of the third stage.
- To maximize safety for the mother and infant, collection should be made from the ex utero separated placenta.
- Collection should be by a trained third party (that is not by the attending obstetrician or midwife)
- The service should not be made available in cases where the attending clinician believes it to be contraindicated: this will be likely to include all premature births and cases where there appear to the attendants to be specific contraindications, such as nuchal cord or maternal haemorrhage.
REFERENCES
1. Umbilical Cord Blood Banking. Scientific Advisory Committee Opinion Paper 2. Royal College of Obstetricians & Gynaecologists. June 2006.
2. Couri CE, Oliveira MC, Stracieri AB et al. C-peptide levels and insulin independence following autologous nonmyeloablative hematopoietic stem cell transplantation in newly diagnosed type 1 diabetes mellitus. JAMA 2009; 301(15): 1573-9.
3. Gordon MY, Levicar N, Pai M et al. Cahracterization and clinical application of human CD34+ stem/progenitor cell populations mobilized into the blood by granulocyte colony-stimulating factor.
